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f3~~tarafion of Dorr;f•:1...: ~:~i<<zE~shi~~
4~9~?43
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E COUNTY. FLORIDA:
This is m7 declaration of Domicile and Citisenship in the State of Florida that I am filing this da] in aocordanoe. and is
coaformit] with Section 2?2.17. Florida Statutes.
I was f
~
r~l a legal resident of ~,.1, ~ ~ ~ ~ I
(Cttj1 l8tata!
resided at ~ ~ 3.Q
n~4~
~ - However. I have changed m] domicile to
lStraat and NusDarl
and am and have been a bona fide resident of the State opt Fbrida since ~h P ~ ~ ~
_ 19~ and I wide at ~ I ~ ~ +
- (8trnt and Namb~H
p 1 _ ST . L UG i E Count]. Florida.
_ t~l
and this statement is to be taken as m] decLration of citizenship. actual legal residence and domicile in the State ai Florida.
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IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: •
- F LEO iN~ :.oEO i
:~.WCI£ FLA. 1
acc_r - s~
IlECQ~' i ~ = ' = .
DEC 119 3o AN '1g .
4S9n43 1
I FURTHER CERTIFY that I w171 register at m] local address when the registration books reopen. and eompl] with all
other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain is
T. L V L 1 C . COUnt].
` ICS])
Florida. permaaenti; .
• = ~5 h a R o ni ~ ~z-ro~!
.mow ~ _
Sworn to me this ~ da] of % ~ ~
€ 9
A.D.18_ ~ 1
~ - ROGER P'01 TRAS. CLERK OF G IRGUI T COURT
ST. L COUNTY, fLOR oA ,
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BY: -
rn~ ~
EPUTY t.ERK
BOOK ~2~ PAGf ~ 1 OV -
AGn Form "1 'L2 -